[A] House health care package has been pared down again as lawmakers careen toward adjournment. In all, lawmakers plan to raise $12 million for a health care bill that has languished in House Appropriations for several weeks.
What started out as Gov. Peter Shumlin’s grand plan to help poor Vermonters get better access to hospitals and physicians has shrunk over the past four months to an attempt to shore up a weakened primary care system and provide subsidies to low-income Vermonters.
Shumlin proposed a $90 million payroll tax that would have increased Medicaid reimbursements to health care providers by 20 percent. The governor has said too many Vermonters receiving Medicaid benefits are turned away because the reimbursement rate is too low.
But the House rejected the governor’s proposal. Instead, lawmakers have proposed scaled down versions of the package. First the funding proposal was $52 million, then it was bargained down to $22 million.
Now several members of the House Ways and Means Committee say leadership is zeroing in on $12 million in new revenue to increase Medicaid payments for primary care and subsidies offered through the state health care exchange, as well as several other less costly initiatives aimed at increasing access and reducing the cost of care over time.
The funding would come from a combination of increases to the sales tax for items such as soda, candy and cigarettes, and an increase to the employer assessment — a per employee tax on businesses that don’t offer health care or have employees that opt for Medicaid instead of the employer sponsored benefit, the committee members said.
Rep. Janet Ancel, D-Calais, would not confirm the $12 million figure or the precise taxes being considered, saying “we haven’t settled on something as a committee,” but she did affirm that efforts to “salvage” a health care package are underway. Rep. Mitzi Johnson, D-South Hero, chair of House Appropriations, and Rep. Bill Lippert, chair of House Health Care, were tight-lipped about the plan, too.
All three legislators said the particulars are part of the ongoing conversation.
Johnson said the size and scope of the package will be limited by what’s “workable” and “necessary.” The sunset of a federal bump in Medicaid payments for primary care “jeopardizes the long-term health of our primary care system,” Johnson said, but added that the necessary priorities “depend on who you talk to.”
The route to passage for the package is less clear. The underlying legislation, H.481, sits in the House Appropriations Committee. Ancel said leadership is trying to build up a “stronger margin” before bringing it to the floor. It’s stalled in that committee for weeks, largely because of opposition to an excise tax on sweetened beverages.
“I don’t think the path has been established,” Ancel said.
One possibility is that if key committee chairs in the House and Senate can agree on the spending and revenue in the package, it could be incorporated back into the Senate version of the budget.
The chairs of Senate Health and Welfare and Appropriations Committees have stated a preference for that option. Such a strategy has some obvious advantages. The budget is must-pass legislation that clears the path to adjournment. Or, as Sen. Claire Ayer, D-Addison, chair of Senate Health and Welfare put it, putting the package in the budget makes the components harder to “pick off.”
Sen. Tim Ashe, D/P-Chittenden, chair of Senate Finance, said Tuesday that the House and Senate have a “conceptually similar framework” for health care spending and have identified priorities that are “not too far off” from one another. He would like to see the primary care boost “targeted” to “acute problems” such as access to mental health services or pediatric dental care, Ashe said.
Ashe and Ayer have also introduced a bill, S.135, that focuses on long-term health care reform policies, such as expanding the Green Mountain Care Board’s powers and authority, and changing how health care providers are compensated.
S.135 is another possible vehicle for portions of the health care package the House is working to salvage.